An asymptomatic 20-year-old woman is incidentally found to have a bicuspid aortic valve. Fusion of the left and right coronary cusps is noted and there is moderate stenosis with a peak echocardiogram gradient of 3.2 meters/second. There is also mild aortic insufficiency. The left ventricular size is normal and the ejection fraction is 62%. The ascending aorta measures 3.8 cm. Her past history is significant for hypothyroidism and short stature. Which of the following is the next best step in the management of this patient?
A. Cardiac MRI
B. Exercise testing
C. Chromosome analysis with a karyotype
D. Cardiac catheterization
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